OPHTE #) - 5 -31SII Harnett County Department of Public Health 23149
PERMIT #75315 Operation Permit
New Installation X Septic Tank "'� Nitrification Line 1:1 Repair El Expansion
PROPERTY LOCATION: ejtzo b-) �o
Name: (owner) \A sL- t_% SUBDIVISION L-- L -C, �?—\vcA� G. LOT # � 2
System Installer: <-F Registration #
Basement with plumbing: ❑ Garage **� Number of Bedrooms 4'
Type of Water Supply: ❑ Community Y Public ❑ Well Distance from well fwd feet
System Type: "_ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the abov capt ed property.
Type of system: El Conventional )4 Other Sh1AM � �QQ Septic Tank: 10OC9 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field disc , _ 1+ of each ditch t b O feet ditches feet ditches inches
French Drain Reauired: Linea feet
Authorized State Agent �__ _�� � P- _5 Date 3 l sit
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